Provider Demographics
NPI:1265488563
Name:SYRACUSE ASC, LLC
Entity Type:Organization
Organization Name:SYRACUSE ASC, LLC
Other - Org Name:SPECIALTY SURGERY CENTER OF CNY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ROWENA
Authorized Official - Middle Name:
Authorized Official - Last Name:ILAG-FERGUSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-451-6911
Mailing Address - Street 1:225 GREENFIELD PKWY
Mailing Address - Street 2:SUITE 105
Mailing Address - City:LIVERPOOL
Mailing Address - State:NY
Mailing Address - Zip Code:13088-6666
Mailing Address - Country:US
Mailing Address - Phone:315-451-6911
Mailing Address - Fax:315-451-1540
Practice Address - Street 1:225 GREENFIELD PKWY
Practice Address - Street 2:SUITE 105
Practice Address - City:LIVERPOOL
Practice Address - State:NY
Practice Address - Zip Code:13088-6666
Practice Address - Country:US
Practice Address - Phone:315-451-6911
Practice Address - Fax:315-451-1540
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3331212R261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYBB8529Medicare PIN